hepatitis b viral infection

8/8/2019 Hepatitis B Viral Infection

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Hepatitis B/Serum Hepatitis


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Hepatitis B is a potentially life-threatening liver infection caused bythe hepatitis B virus. It is a major global health problem and the mostserious type of viral hepatitis. It can cause chronic liver disease andputs people at high risk of death from cirrhosis of the liver and livercancer.


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a l s ll articl c tai i DNAc s f:

c r a ti (HBcAg); s rfac a ti (HBsAg) ;a a t r a ti f wit i t c r( HBeAg) t at circ lat s i t l ;(HBxAg) t r ct f X f V/DNA


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HBsAg 1-2 weeks after exposure and 2 to 8weeks before onset

of symptoms

or an increase in transferase ( transaminase) levels.Patients with HBsAg that persist for 6 or more mos.

after infection = HBsAg Carriers

HBeAg - the next antigen to appear in the serum. It usually

appears w/in a week of the appearance of HBsAg andbefore changes in aminotransferase levels,

disappearing from the serum w/in 2 weeks.

HbcAg not always detected in HBV infection.

e.g. Anti-HBsAg positive = positive HBV infection


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About 25% of adults

who become chronically

infected duringchildhood later die from

liver cancer or cirrhosis

(scarring of the liver)

caused by the chronic

infection.

The hepatitis B virus is 50 to100 times more infectious

than HIV.

Hepatitis B virus is an

important occupational hazard

for health workers.

Hepatitis B is preventable

with a safe and effective

vaccine.


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E ic i C i a a t r arts f AsiaMost opl i t r ion come infected wit V during

c ildhood. In these regions, 8% to 10% of the adult populationare chronically infected.

Liver cancer caused y V is among the first three causes ofdeathfrom cancer inmen, and a major causeof cancer in women.

igh rates of chronic infections are also found in theAmazon andthe southernparts ofeastern and central Europe.

In theMiddle East and Indian sub-continent,anestimated 2% to 5% of thegeneral population is chronicallyinfected.

Less than 1% of thepopulation in western Europe and North

American is chronically infected.


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Healthworkers are at high risk!!!


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Pre-icteric stage:

nonspecific, flulike symptoms like low grade fever, malaise,fatigue, myalgias, chills,

anorexia, nausea and vomiting, abdominal discomfort, diarrhea.

Icteric stage:

occurs a few days to weeks after the pre-icteric stage: jaundice, dark-

colored urine, light-colored stool, steatorrheah, and hepatomegaly.

Ascites , bleeding

Posticteric stage: convalescent stage lasting a few weeks, fatigue

decreases, jaundice resolves and appetite returns.


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Icteric sclera

Ascites ( edema )


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Compliment fixation

Radio-immunoassay-hemaglutinin test

Liver function test

Bile examination in blood and urine

Blood count

Serum transaminase SGOT, SGPT, ALT

HbsAg


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No specific treatment

ed rest

Dietmust behigh in carbohydrate, low in fat, and low inprotein.

Vitamin supplement especially the complex group

Intravenous therapy/ fluid replacement

interferon and anti-viral agents

Isoprinosine (methisoprenol)may enhance the cell-mediated immunity of the

T-lymphocytes

Alkalies, belladonna, and anti-emetics shouldbe administered to control

dyspepsia andmalaise

liver transplants


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Treatment can cost thousands of dollars per year and is notavailable tomost patients in developing countries.

Liver cancer is almost always fatal, and often develops inpeople at an age when they are most productive and have

family responsibilities.

In developing countries, most people withliver cancer diewithin months of diagnosis.

In higher income countries, surgery and chemotherapycan prolong life for up to a few years in some patients.


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Blooddonors must be screened toexclude carriers.

Cautionmust beobserved ingiving care

topatients with knownHBV.

Hands andother skin areas must be washed immediately and

thoroughly after contact withbloody fluids.

Avoid injury with sharpobjects or instruments.

Usedisposableneedles and syringes only once

anddiscardproperly.


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Avoid sharingof toothbrush, razor, andother instruments thatmaybe contaminated withblood.

Observe safe sex.

Have adequate rest, sleep, andexercise, andeat nutritiousfood.

Hepatitis B vaccine is recommended for pre-exposure.

Hepatitis ImmuneGlobulin (HBIg) shouldbe administeredwithin

72 hours to thoseexposeddirectly tohepatitis B virus either byingestion, by prick or by inoculation.


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Prevention

All infants should receive thehepatitis B vaccine.

----given as either threeor four separatedoses, as part ofexistingroutine immunization schedules.

In areas wheremother-to-infant spreadofHBV is common, the firstdoseof vaccine shouldbegiven as soon as possible after birth (i.e.within 24 hours).

The complete vaccine series induces protective antibody levels inmore than 95% of infants, children and young adults.

After age 40, protection following theprimary vaccination seriesdrops below 90%. At 60 years old, protective antibody levels areachieved inonly 65 to75% of those vaccinated.

Protection lasts at least 20 years and shouldbe lifelong.


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All children and adolescents younger than 18 years old and notpreviously vaccinated should receive the vaccine.

People inhigh risk groups should also be vaccinated, including:

personswithhigh-risk sexual behaviour;

partners and household contacts of HBV infected persons;

injecting drug users;

personswho frequently require blood or blood products;

recipients of solid organ transplantation;

those at occupational risk of HBV infection, includinghealth careworkers; and

international travellers to countrieswithhigh rates of HBV.


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Knowledge deficit

Low self esteem

Body image disturbance

Risk for infection

Impaired skin integrity

Altered nutrition: less than

body requirements

Socialisolation

Acute Pain


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hepatitis b viral infection

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